DR. DAEDALUS.(eccentric plastic surgeon Joe Rosen)(Interview)

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DR. DAEDALUS.(eccentric plastic surgeon Joe
Rosen)(Interview)
Harper's Magazine, July, 2001, by Lauren Slater

A radical plastic surgeon wants to give you wings

PART I: BEAUTIFUL PEOPLE

Joe Rosen, plastic surgeon at the renowned Dartmouth-Hitchcock
Medical Center, and by any account an odd man, has a cold. But
then again, he isn't sure it's a cold. "It could be anthrax," he says as
he hurries to the car, beeper beeping, sleet sleeting, for it's a
freezing New England midwinter day when all the world is white.
Joe Rosen's nose is running, his throat is raw, and he's being called
into the ER because some guy made meat out of his forefinger and
a beautiful teenager split her fine forehead open on the windshield
of her SUV. It seems unfair, he says, all these calls coming in on a
Sunday, especially because he's sick and he isn't sure whether it's
the flu or the first subtle signs of a biological attack. "Are you
serious?" I say to him. Joe Rosen is smart. He graduated cum laude
from Cornell and got a medical degree from Stanford in 1978. And
we're in his car now, speeding toward the hospital where he
reconstructs faces, appends limbs, puffs and preens the female
form. "You really wonder," I say, "if your cold is a sign of a
terrorist attack?"

Joe Rosen, a respected and controversial plastic surgeon, wonders a
lot of things, some of them directly related to his field, others not.
Joe Rosen wonders, for instance, whether Osama bin Laden
introduced the West Nile virus to this country. Joe Rosen wonders
how much bandwidth it would take to make virtual-reality contact
lenses available for all. Joe Rosen wonders why both his ex-wife
and his current wife are artists, and what that says about his deeper
interests. Joe Rosen also wonders why we insist on the kinds of
conservative medical restraints that prevent him from deploying

some of his most creative visions: wings for human beings;
cochlear implants to enhance hearing, beefing up our boring ears
and giving us the range of an owl; super-duper delicate rods to jazz
up our vision--binocular, beautiful--so that we could see for many
miles and into depths as well. Joe Rosen has ideas: implants for
this, implants for that, gadgets, gears, discs, buttons, sculpting soft
cartilage that would enable us, as humans, to cross the frontiers of
our own flesh and emerge as something altogether ... what?
Something other.

And we're in the car now, speeding on slick roads toward the
hospital, beeper beeping, sleet sleeting, passing cute country houses
with gingerbread trim, dollops of smoke hanging above bright brick
chimneys; his New Hampshire town looks so sweet. We pull into
the medical center. Even this has a slight country flair to it, with
gingham curtains hanging in the rows of windows. We skid. Rosen
says, "One time I was in my Ford Explorer with my daughter, Sam.
We rolled, and the next thing I knew we were on the side of the
highway, hanging upside down like bats." He laughs.

We go in. I am excited, nervous, running by his bulky side with my
tape recorder to his mouth. A resident in paper boots comes up to
us. He eyes the tape recorder, and Rosen beams. Rosen is a man
who enjoys attention, credentials. A few days ago he boasted to me,
"You shouldn't have any trouble with the PR people in this hospital.
I've had three documentaries made of me here already."

"Can I see them?" I asked.

"I don't know," Rosen answered, suddenly scratching his nose very
fast. "I guess I'm not sure where I put them," and something about
his voice, or his nose, made me wonder whether the documentaries
were just a tall tale.

Now the resident rushes up to us, peers at the tape recorder, peers
at me. "They're doing a story on me," Rosen says. "For Harper's."

"Joe is a crazy man, a nutcase," the resident announces, but there's
affection in his voice.

"Why the beeps?" Rosen asks.

"This guy, he was working in his shop, got his finger caught in an
electric planer ... The finger's hamburger," the resident says. "It's
just hamburger."

We go to the carpenter's cubicle. He's a man with a burly beard and
sawdust-caked boots. He lies too big for the ER bed, his dripping
finger held high in the air and splinted. It does look like hamburger.

I watch Rosen approach the bed, the wound. Rosen is a largish
man, with a curly head of hair, wearing a Nordstrom wool coat and
a cashmere scarf. As a plastic surgeon, he thinks grand thoughts
but traffics mostly in the mundane. He has had over thirty papers
published, most of them with titles like "Reconstructive Flap
Surgery" or "Rhinoplasty for the Adolescent." He is known among
his colleagues only secondarily for his epic ideas; his respect in the
field is rooted largely in his impeccable surgical skill with all the
toughest cases: shotgunned faces, smashed hands.

"How ya doin'?" Rosen says now to the carpenter. The carpenter
doesn't answer. He just stares at his mashed finger, held high in the
splint.

Rosen speaks softly, gently. He puts his hand on the woodworker's
dusty shoulder. "Looks bad," he says, and he says this with a kind
of simplicity--or is it empathy?--that makes me listen. The patient
nods. "I need my finger," he says, and his voice sounds tight with
tears. "I need it for the work I do."

Rosen nods. His tipsiness, his grandiosity, seem to just go away. He
stands close to the man. "Look," he says, "I'm not going to do
anything fancy right now, okay? I'll just have my guys sew it up,
and we'll try to let nature take its course. I think that's the best
thing, right now. To let nature take its course."

The carpenter nods. Rosen has said nothing really reassuring, but
his tone is soothing, his voice rhythmic, a series of stitches that
promises to knit the broken together.

We leave the carpenter. Down the hall, the teenage beauty lies in
still more serious condition, the rent in her forehead so deep we can
see, it seems, the barest haze of her brain.

"God," whispers Rosen as we enter the room. "I dislike foreheads.
They get infected so easily."

He touches the girl. "You'll be fine," he says. "We're not going to
do anything fancy here. Just sew you up and let nature take its
course."

I think these are odd, certainly unexpected words coming from a
man who seems so relentlessly anti-nature, so visionary and
futuristic in his interests. But then again, Rosen himself is odd, a
series of swerves, a topsy-turvy, upside-down, smoke-and-mirrors
sort of surgeon, hanging in his curious cave, a black bat.

"I like this hospital," Rosen announces to me as we leave the girl's
room. "I like its MRI machines." He pauses.

"I should show you a real marvel," he suddenly says. He looks
around him. A nurse rushes by, little dots of blood on her snowy
smock. "Come," Rosen says.

We ride the elevator up. The doors whisper open. Outside, the sleet
has turned to snow, falling fast and furious. The floor we're on is
ominously quiet, as though there are no patients here, or as though
we're in a morgue. Rosen is ghoulish and I am suddenly scared. I
don't know him really. I met him at a medical-ethics convention at
which he discussed teaching Frankenstein to his residents and
elaborated, with a little light in his eye, on the inherent beauty in
hybrids and chimeras, if only we could learn to see them that way.
"Why do we only value the average?" he'd asked the audience.
"Why are plastic surgeons dedicated only to restoring our current
notions of the conventional, as opposed to letting people explore, if
they want, what the possibilities are?"

Rosen went on to explain other things at that conference. It was
hard for me to follow his train of thought. He vacillates between
speaking clearly, almost epically, to mumbling and zigzagging and
scratching his nose. At this conference he kangaroo-leapt from
subject to subject: the army, biowarfare, chefs with motorized
fingers that could whip eggs, noses that doubled as flashlights,
soldiers with sonar, the ocean, the monsters, the marvels. He is a

man of breadth but not necessarily depth. "According to medieval
man," Rosen said to the convention, finally coming clear, "a
monster is someone born with congenital deformities. A marvel,"
he explained, "is a person with animal parts--say, a tail or wings."
He went on to show us pictures, a turn-of-the-century newborn
hand with syphilitic sores all over it, the fingers webbed in a way
that might have been beautiful but not to me, the pearly skin
stretched to nylon netting in the crotch of each crooked digit.

And the floor we're on now is ominously quiet, except for a hiss
somewhere, maybe some snake somewhere, with a human head.
We walk for what seems a long time. My tape recorder sucks up
the silence.

Rosen turns, suddenly, and with a flourish parts the curtains of a
cubicle. Before me, standing as though he were waiting for our
arrival, is a man, a real man, with a face beyond description.
"Sweeny,"(*) Rosen says, gesturing toward the man, "has cancer of
the face. It ate through his sinus cavities, so I scraped off his face,
took off his tummy fat, and made a kind of, well, a new face for
him out of the stomach. Sweeny, you look good!" Rosen says.

Sweeny, his new face, or his old stomach, oozing and swollen from
this recent, radical surgery, nods. He looks miserable. The
belly-face sags, the lips wizened and puckered like an anus, the
eyes in their hills of fat darting fast and frightened.

"What about my nose?" Sweeny says, and then I notice: Sweeny
has no nose. The cancer ate that along with the cheeks, etc. This is
just awful. "That comes next. We'll use what's left of your
forehead." A minute later, Rosen turns to me and observes that
pretty soon women will be able to use their buttocks for breast
implants. "Where there's fat," Rosen says, "there are possibilities."

The coffee is hot and good. We drink it in the hospital cafeteria
while we wait for the weather to clear. "You know," Rosen says,
"I'm really proud of that face. I didn't follow any protocol. There's
no textbook to tell you how to fashion a face eaten away by cancer.
Plastic surgery is the intersection' of art and science. It's the
intersection of the surgeon's imagination with human flesh. And
human flesh," Rosen says, "is infinitely malleable. People say

cosmetic surgery is frivolous--boobs and noses. But it's so much
more than that! The body is a conduit for the soul, at least
historically speaking. When you change what you look like, you
change who you are."

I nod. The coffee, actually, is too damn hot. The delicate lining of
skin inside my mouth starts to shred. The burn-pain distracts me. I
hive temporarily altered my body, and thus my mind. For just one
moment, I am a burned-girl, not a writer-girl. Rosen may be
correct. With my tongue I flick the loose skin, picture it, pink and
silky, on fire.

No, plastic surgery is not just boobs and noses. Its textbooks are
tomes--thick, dusty, or slick, no matter--that all open up to images
of striated muscle excised from its moorings, bones--white,
calcium-rich--elongated by the doctor's finest tools. Plastic surgery,
as a medical specialty, is very confusing. It aims, on the one hand,
to restore deformities and, on the other hand, to alter the normal.
Therefore, the patients are a motley crew. There is the gorgeous
blonde with the high sprayed helmet of hair who wants a little
tummy tuck, even though she's thin, and then there is the Apert
Syndrome child, the jaw so foreshortened the teeth cannot root in
their sockets. Plastic surgery--like Rosen, its premier
practitioner--is flexible, high-minded, and wide-ranging, managing
to be at once utterly necessary and ridiculously frivolous, all in the
same breath, all in the same scalpel.

According to the American Society of Plastic Surgeons, last year
more than 1.3 million people had cosmetic surgery performed by
board-certified plastic surgeons, an increase of 227 percent since
1992. (These numbers do not include medically necessary or
reconstructive surgeries.) The five most popular procedures were
liposuction (229,588), breast augmentation (187,755), eyelid
surgery (172,244), the just available Botox injections (118,452),
and face lifts (70,882). Most cosmetic surgeries are performed on
women, but men are catching up: the number of men receiving
nose jobs--their most popular procedure--has increased 141 percent
since 1997. The vast majority of patients are white, but not
necessarily wealthy. A 1994 study found that 65 percent of
cosmetic-surgery patients had a family income of less than $50,000,

even though neither state nor private health insurance covers the
cost of cosmetic surgeries. These figures alone point to the
tremendous popularity and increasing acceptance of body alteration,
and suggest that the slippery slope from something as bizarre as
eyelid tucks to something still more bizarre, like wings, may be
shorter than we think.

This medical specialty is ancient, dating back to 800 B.C., when
hieroglyphics describe crude skin grafts. Rosen once explained to
me that plastic surgery started as a means to blur racial differences.
"A long time ago," he'd said, "Jewish slaves had clefts in their ears.
And some of the first plastic-surgery operations were to remove
those signs of stigma."

One history book mentions the story of a doctor named Joseph
Dieffenbach and a man with grave facial problems. This man had
the sunken nose of syphilis, a disease widely associated with
immorality. Dieffenbach, one of the fathers of plastic surgery, so
the story goes, devised a gold rhinoplasty bridge for this marginal
man, thus giving him, literally, a Midas nose and proving, indeed,
that medicine can make criminals kings.

As a field, plastic surgery is troubled, insecure. It is a lot like
psychiatry, or dentistry, in its inferior status as a subspecialty of
medicine. In fact, the first plastic-surgery association, started in
1921, was an offshoot of oral practitioners. Read: teeth people. Not
to digress, but the other day I woke up with a terrible toothache and
rushed in to see a dentist. I said to him, just to be friendly, "What
sort of training do you need for your profession?" He said, "You
need A LOT of training, believe me. I trained with the same guys
who cure your cancer, but I don't get the same respect."

I wonder if Rosen ever feels like my dentist, and if that's why he's
so grandiose, like the little boy who is a bully. Sander Gilman, a
cultural critic of plastic surgery, writes that, in this group of
doctors, there are a lot of big words thrown around in an effort to
cover up the sneaking suspicion that their interventions are not
important. One is not ever supposed to say "nose job"; it's called
rhinoplasty. Gilman writes, "The lower the perceived status of a
field ... the more complex and `scientific' the discourse of the field

becomes."

Of course, I rarely meet a doctor who doesn't like jargon and
doesn't like power. Rosen may be different only in intensity. "I'm
not a cosmetic surgeon," Rosen keeps repeating to me. He says,
"Really, there's no such thing as just cosmetic surgery. The skin
and the soul are one." On paper, maybe, this comment seems a
little overblown, but delivered orally, in a New England town when
all the world is white, it has its lyrical appeal.

When Rosen cries out that he's not "just a cosmetic surgeon," he's
put his finger on a real conflict in his field. Where does necessary
reconstruction end and frivolous interventions begin? Are those
interventions really frivolous, or are they emblematic of the huge
and sometimes majestic human desire to alter, to transcend? If
medicine is predicated upon the notion of making the sick well, and
a plastic surgeon operates on someone who is not sick, then can the
patient truly be called a patient, and the doctor a doctor? Who pays
for this stuff, when, where, and how? These are the swirling
questions. Over a hundred years ago Jacques Joseph, another of
plastic surgery's founding fathers, wrote that beauty was a medical
necessity because a person's looks can create social and economic
barriers. Repairing the deformity, therefore, allows the man to
function in a fully healthy way in society. Voila. Function and
form, utilitarianism and aestheticism, joined at the hip, grafted
together: skin tight.

Perhaps we can accept Joseph's formulation. Okay, we say. Calm
down. We say this to all the hopping, hooting cosmetic surgeons
who want to stake out their significance. Okay, we respect you. I'd
like to say this to Rosen, but I can't. Rosen's ideas and aspirations,
not to mention his anthrax concerns, go beyond what I am
comfortable with, though I can't quite unearth the architecture of
my concerns. After all, he doesn't want to hurt anyone. Maybe it's
because Rosen isn't just talking about everyday beauty and its
utilitarian aspects. He is talking EXTREMES. When Rosen thinks
of beauty, he thinks of the human form stretched on the red-hot
rack of his imagination, which is mired in medieval texts and books
on trumpeter swans. At its outermost limits, beauty becomes
fantastical, perhaps absurd. Here is where Rosen rests. He dreams

of making wings for human beings. He has shown me blueprints,
sketches of the scalpel scissoring into skin, stretching flaps of torso
fat to fashion gliders piped with rib bone. When the arm stretches,
the gliders unfold, and human floats on currents of air. Is he
serious? At least partially. He gives lectures to medical students on
the meaning of wings from an engineering perspective, a surgeon's
perspective, and a patient's perspective. He has also thought of
cochlear implants to enhance normal hearing, fins to make us
fishlike, and echolocation devices so that we can better navigate the
night. He does not understand the limits we place on hands. He
once met a Vietnamese man with two thumbs on one hand. This
man was a waiter, and his two thumbs made him highly skilled at
his job. "Now," says Rosen, "if that man came to me and said, `I
want you to take off my extra thumb,' I'd be allowed, but I wouldn't
be allowed to put an extra thumb on a person, and that's not fair."

We can call Rosen ridiculous, a madman, a monster, a marvel. We
could dismiss him as a techno geek or a fool or just plain
immature. But then there are the facts. First of all, Rosen is an
influential man, an associate professor of surgery at Dartmouth
Medical School and the director of the Plastic Surgery Residency
Program at the medical center. He was senior fellow at the C.
Everett Koop Institute from 1997 to 1998, and he has also served
on advisory panels for the navy and for NASA's Medical Care for
the Mission to Mars, 2018. Rosen consults for the American
Academy of Sciences committee on the role of virtual-reality
technology, and he is the former director of the Department of
Defense's Emerging Technology Threats workforce. In other words,
this is a man taken seriously by some serious higher-ups.
"Echolocation devices," Rosen explains, "implanted in a soldier's
head, could do a lot to enhance our military capacity." And this
isn't just about the army's fantasies of the perfect soldier. Rosen
travels worldwide (he gave over a dozen presentations last year)
and has had substantial impact not only scalpeling skin but
influencing his colleagues' ethics in a myriad of ways. "He has been
essential in helping me to conceptualize medicine outside of the
box," says Charles Lucey, MD, a former colleague of Rosen's at the
Dartmouth Medical School. John Harris, a medical-ethics specialist
in Manchester, England, writes in Wonderwoman and Superman
that "in the absence of an argument or the ability to point to some

specific harm that might be involved in crossing species
boundaries, we should regard the objections per se to such practices
... as mere and gratuitous prejudice." Rosen himself says, "Believe
me. Wings are not way off. It is not a bad idea. Who would have
thought we'd ever agree to hold expensive, potentially dangerous
radioactive devices up to our ears for hours on end, day after day,
just so we could gossip. That's cell phones for you," he says. And
smiles.

Rosen has a nice smile. It's, to be sure, a little boyish, but it's
charming. Sometimes Rosen is shy. "I mumble a lot," he
acknowledges. "I don't really like people. I don't really like the
present. I am a man who lives in the past and in the future only."

Now we leave the emergency room. The snow has stopped. The
roads are membraned with ice. The sun is setting in the New
Hampshire sky, causing the hills to sparkle as though they're full of
little lights and other electric things. We drive back to his house,
slowly. The emergencies are over, the patients soothed or suffering,
he has done what can be done in a day, and still his nose runs. He
coughs into his fist. "Truth be told," he says to me, "I didn't start
out wanting to be a surgeon, even though I always, ALWAYS, had
big ideas. In kindergarten, when the other kids were making these
little ditsy arts-and-crafts projects, I was building a room-size
Seventh Fleet ship." He goes on. As a child he wanted to be an
artist. In high school he became obsessed with Picasso's Guernica
and spent months trying to replicate it in the style of Van Gogh. As
a freshman at Cornell, he made a robotic hand that could crack his
lobster for him, and from then on it was hands, fingers, knees, and
toes. His interests in the technical aspects of the body drew him
away from the arts and eventually into medical school, which was,
in his mind, somewhere between selling out and moving on.

We pull into his driveway. Rosen lives in a sprawling ranch-style
house. He has a pet hen, who waits for us in the evergreen tree. His
second wife, Stina Kohnke, is young and, yes, attractive. I'm afraid
to ask how old she is; he looks to be at least fifty-three and she
looks twenty-three, though maybe that's beside the point.
Nevertheless, it all gets thrown into my mental stew: grandiose
man, military man, medicine man, wants to make wings, young

thing for a mate. Rooster and hen. Maybe there is no story here.
Maybe there's just parody. All breadth, no depth. Except for this.
Everyone I tell about Rosen and his wings, his fin de siecle mind,
widens his or her eyes, leans forward, and says, "You're kidding."
People want to hear more. I want to hear more. His ideas of altering
the human form are repugnant and delicious, and that's a potent
combination to unravel. And who among us has not had flying
dreams, lifted high, dramatically free, a throat-catching fluidity in
our otherwise aching form, above the ocean, all green, like moving
marble?

Rosen and his wife have invited me for dinner. I accept. Stina is an
artist. Her work is excellent. "Joe is an inspiration for me," she
says. "He brings home pictures of his patients, and I sculpt their
limbs from bronze." In her studio, she has a riot of red-bronze
deformed hands clutching, reaching, in an agony of stiffness. She
has fashioned drawer pulls from gold-plated ears. You go to open
the breadbox, the medicine cabinet, the desk drawer, and you have
to touch these things. It's at once creepy and very beautiful.

We sit at their stone dining-room table. Behind us is a
seventy-gallon aquarium full of fish. Cacti, pink and penile, thrust
their way into the odd air. Stina, homesick for her native California,
has adorned the living room with paper palm trees and tiny live
parakeets. We talk. Stina says, "Joe and I got married because we
found in each other the same aesthetic and many moral equivalents.
We found two people who could see and sculpt the potential in
what others found just ugly."

"How did you two meet?" I ask.

"Oh, I knew Stina's sister, who was an art professor ... That sort of
thing," mumbles Rosen.

"I kissed him first," says Stina. She reaches across the table, picks
up Rosen's hand, and wreathes her fingers through his. She holds
on tightly, as if she's scared. I study Stina. She is conventionally
pretty. She has a perfect Protestant nose and a lithe form, and a
single black bra strap slips provocatively from beneath her blouse.
Rosen, a man who claims to love the unusual, has picked a very
usual beauty.

"Look!" Stina suddenly shouts. I jump, startled. "Look at her ears!"
she says to Rosen.

Before I know it they are both leaning forward, peering at my ears.
"Oh, my God," says Stina, "you have the most unusual ears."

Now, this is not news to me. I have bat ears, plain and simple.
They stick out stupidly. In the fifth grade, I used to fasten them to
the sides of my skull with pink styling tape in the hope of altering
their shape. I have always disliked my ears.

Rosen uncurls his index finger and touches my left ear. He runs his
finger along the bumpy, malformed rim. "You're missing the
scapha," he says. "It's a birth defect."

"I have a birth defect?" I say. I practically shout this, being
someone who desires deeply not to be defective. That's why I take
Prozac every day.

"Joe," says Stina, "are those not the most amazing ears. They
would be so perfect to sculpt."

"They're just a perfect example," Rosen echoes, "of the incredible,
delectable proliferation of life-forms. We claim most life-forms
gravitate toward the mean, but that's not true. Lots of valid life
exists at the margins of the bell curve. You have beautiful ears," he
says to me.

"I have nice ears?" I say. "Really?"

This is just one reason why I won't dismiss Rosen out of hand.
Suddenly, I see my ears a little differently. They have a marvelous
undulating ridge and an intricately whorled entrance, and they do
not stick out so much as jauntily jut; they are ears with an attitude.
Rosen has shifted my Vision without even touching my eyes. He is,
at the very least, a challenger of paradigms; he calls on your
conservatism, pushes hard.

That night, I do not dream of wings. I dream of Sweeny and his
oozing face. I dream he comes so close to me that I smell him.
Then I wake up. Sweeny is very sick. He is going to die soon.

Earlier in the day, I asked Rosen when, and Rosen said, "Oh,
soon," but he said it as if he didn't really care. Death does not seem
to interest Rosen. Beauty, I think, can be cold.

PART II: MONSTER AND MARVELS

Today, Rosen and I are attending a conference together in
Montreal. Here, everyone speaks French and eats baguettes. The
conference room is old-fashioned, wainscoted with rich mahogany,
ornate carvings of creatures and angels studding the ceiling, where
a single light hangs in a cream-colored orb. Around the table sit
doctors, philosophers, graduate students: this is a medical-ethics
meeting, and Rosen is presenting his ideas. On the white board, in
bold black lines, he sketches out his wings, and then the discussion
turns to a patient whose single deepest desire was to look like a
lizard. He wanted a doctor to split his tongue and scale his skin,
and then put horns on his head. "You wouldn't do that, would you?"
a bespectacled doctor asks. "Once," says Rosen, dodging in a
fashion typical of him, "there was a lady in need of breast
reconstruction who wanted blue areolas. What's wrong with blue
areolas? Furthermore, rhinoplasty has not reached its real potential.
Why just change the nose? Why not change the gene for the nose,
so that subsequent generations will benefit from the surgery. Plastic
surgery, in the future, can be about more than the literal body. It
can be about sculpting the genotype as well."

The bespectacled doctor raises his hand. "Would you make that
man into a lizard?" the doctor asks again. "What I want to know is,
if a patient came to you and said, `I want you to give me wings,' or,
`Split my tongue,' would you actually do it?"

"Look," says Rosen, "we genetically engineer food. That's an
issue."

"You're not answering my question," the doctor says, growing
angry. Other people are growing angry, too. "Do you see any
ethical dilemmas in making people into pigs, or birds?" another
attendee yells out. This attendee is eating a Yodel, peeling off the
chocolate bark and biting into a swirl of cream.

Rosen darts and dodges. "There is such a thing as liberty," he says.

"Yes," someone says, "but there's such a thing as the Hippocratic
oath too."

This goes on and on. At last a professor of anthropology says, "Just
tell us, clearly, please. Would you give a human being wings, if the
medical-ethics board allowed it?"

Rosen puts down his black marker. He rubs his eyes. "Yes," he
says, "I would. I can certainly see why we don't devote research
money to it. I can see why the NIH would fund work on breast
cancer over this, but I don't have any problem with altering the
human form. We do it all the time. It is only our Judeo-Christian
conservatism that makes us think this is wrong. Who here," he
says, "doesn't try to send their children to the best schools, in the
hopes of altering them? Who here objects to a Palm Pilot, a thing
we clasp to our bodies, with which we receive rapid electronic
signals? Who here doesn't surround themselves with a metal shell
and travel at death-defying speeds? We have always altered
ourselves, for beauty or for power, and so long as we are not
causing harm what makes us think we should stop?"

For a group of intelligent people everyone looks baffled. What
Rosen has said is very right and very wrong, but no one can quite
articulate the core conflicts. After all, we seem to think it's okay to
use education as a way of neuronally altering the brain, but not
surgery. We take Prozac, even Ritalin, to help transform ourselves,
but recoil when it comes to wings. Maybe we're not recoiling.
Maybe wings are just a dumb idea. No one in his right mind would
subject himself to such a superfluous and strenuous operation. Yet
socialite Jocelyne Wildenstein has dedicated much of her life to
turning herself into a cat, via plastic surgery. She has had her lips
enlarged and her face pulled back at the eyes to simulate a feline
appearance. An even more well-known case is Michael Jackson,
who has whitened himself, slimmed his nose, and undergone
multiple other aesthetic procedures. The essential question here is
whether these people are, and forever will be, outliers, or whether
they represent the cutting edge of an ever more popular trend. Carl
Elliott, a bioethicist and associate professor at the University of
Minnesota, recently wrote in The Atlantic about a strange new
"trend" of perfectly healthy folks who desire nothing more than to

have a limb amputated, and about the British doctor who has
undertaken this surgery,believing that if he doesn't amputate the
patients will do it themselves, which could lead to gangrene. Elliott
wonders whether amputation obsession will morph into another
psychiatric diagnosis, whether, like hysteria, it will "catch on." The
metaphor of contagion is an interesting one. Multiple-personality
disorder "caught on"; hysteria caught on. Why then might not an
unquenchable desire for wings or fins catch on, too? In any case,
we use medical/viral metaphors to explain trends, and, in the case
of plastic surgery, we then use medical means to achieve the trend's
demands.

Rosen himself now repeats to the conferees, "We have always
altered ourselves for beauty or for power. The chieftains in a certain
African tribe remove their left ears, without Novocain. Other tribes
put their bodies through intense scarification processes for the sake
of style. In our own culture, we risk our bodies daily to achieve
status, whether it's because we're bulimic or because we let some
surgeon suck fat from us, with liposuction. Wings will be here,"
Rosen says. "Mark my words."

He suddenly seems so confident, so clear. We should do this;
beauty is marvelous and monstrous. Beauty is difference, and yet,
to his patients in the ER just two weeks back, he kept saying, "Let
nature take its course." Perhaps he is more ambivalent than he lets
on.

Later that evening, over dinner, conferees gossip about Rosen.
"He's a creep," someone says. "A megalomaniac," someone else
adds. For a creep or a megalomaniac, though, he's certainly
commanding a lot of attention. Clearly, his notions are provocative.
"The problem with wings," says someone, "is that only rich people
would have them, would be able to afford them. Our society might
begin to see rich people as more godly than ever."

I order a glass of wine. The waitress sets it on the table, where it
blazes in its goblet, bright as a tulip. With this wine, I will tweak
not only my mind but all its neuronal projections as well. My
reflexes will slow down and my inhibitions will lift, making it
possible for me to sound either very stupid or very smart. Is this

wine an ethical problem? I ask the group that.

"Wine is reversible," someone says. "Wings aren't."

"Well, suppose they were reversible," someone says. "Supposing a
surgeon could make wings that were removable. Then would we be
reacting this way?"

"It's a question of degree," a philosopher pipes up. He is bald and
skinny, with bulging eyes. "Rosen is going to the nth degree. It's
not fair to lump that in with necessary alterations, or even
questionably necessary alterations. Without doubt, it is very clear,
diagnostically, that wings are not necessary."

I think about this. I think about what Rosen might say to this. I can
imagine that his answer might have something to do with the
fluidity of the concept of necessary. Four years ago, cell phones
weren't necessary. Now they seem to be. Furthermore, he might
say, if a person wants wings, if wings won't hurt a person, if they
will help a person enjoy life and feel more beautiful, and if, in turn,
the winged woman or man helps us to see beauty in what was
before unacceptable, as we adjust and then come to love the sight
of her spreading and soaring, then isn't this excellent? Later on, in
my hotel room, I stand in front of the mirror, naked. My body
contains eons. Once, we were single cells, then fish, then birds,
then mammals, and the genes for all these forms lie dormant on
their cones of chromosomes. We are pastiches at the cellular,
genetic level. This may be why I fear open spaces, blank pages,
why I often dream my house opens up into endless rooms I never
knew were there, and I float through them with a kind of terror. It
is so easy to seep, to be boundless. We clutch our cloaks of skin.

Back in Boston, I try to ascertain clearly, logically, what so bothers
people about Rosen's ideas. At first glance, it might seem fairly
obvious. I mean, wings. That's playing God. We should not play
God. We should not reach for the stars. Myth after myth has shown
us the dangers of doing so--Icarus, the Tower of Babel; absolute
power corrupts absolutely. Bill Joy, chief scientist at Sun
Microsystems, says, as our technological capabilities expand, "a
sequence of small, individually sensible advances leads to an
accumulation of great power and, concomitantly, great danger."

Rosen's response to this: "So are we supposed to stop advancing?
And who says it's bad to play God? We already alter the course of
God's `will' in hundreds of ways. When we use antibiotics to
combat the flu, when we figure out a way to wipe smallpox off the
very face of the earth, surely we're altering the natural course of
things. Who says the natural course of things is even right? Maybe
God isn't good."

The second objection might have to do with our notions of
categorical imperatives. Mary Douglas wrote in her influential
anthropological study Purity and Danger that human beings have a
natural aversion to crossing categories, and that when we do
transgress we see it as deeply dirty. In other words, shoes in
themselves are not dirty, but when you place them on the
dining-room table they are. When you talk about crossing species,
either at the genetic or the anatomical level, you are mucking about
in long-cherished categories that reflect our fundamental sense of
cleanliness and aesthetics. Rosen's response to this, when I lob it at
him in our next meeting: "Who says taboos are anything but
prejudice at rock bottom? Just because it feels wrong doesn't mean
it is. To a lot of people, racial intermingling and miscegenation feel
wrong, but to me they're fine. I'm not a racist, and I'm not a
conservative."

The third objection I can come up with has to do with the idea of
proteanism. Proteus, a minor mythological figure, could shape-shift
at will, being alternately a tiger, a lizard, a fire, a flood. Robert
Lifton, one of, I think, the truly deep thinkers of the last century,
has explored in his volumes how Proteus has become a symbol for
human beings in our time. Lacking traditions, supportive
institutions, a set of historically rooted symbols, we have lost any
sense of coherence and connection. Today it is not uncommon for a
human being to shift belief systems several times in a lifetime, and
with relatively little psychological discomfort. We are Catholics,
Buddhists, reborn, unborn, artists, and dot-commers until the dot
drops out of the com and it all comes crashing down. We move on.
We remarry. Our protean abilities clearly have their upsides. We
are flexible and creative. But the downside is, there is no psychic
stability, no substantive self, nothing really meaty and authentic.
We sense this about ourselves. We know we are superficial, all

breadth and no depth. Rosen's work embodies this tendency,
literally. He desires to make incarnate the identity diffusion so
common to our culture. Rosen is in our face making us face up to
the fact that the inner and outer connections have crumbled. In our
ability to be everything, are we also nothing?

For me, this hits the nail on the head. I do not object to Rosen on
the basis of concerns about power, or of Mary Douglas's
cross-category pollution theory. After all, who, really, would wings
reasonably benefit but the window washers among us? And as for
the pollution issue, protean person that I am, I could probably
adjust to a little chimerical color. Rosen's ideas and aspirations are
frightening to me because they are such vivid, visceral examples of
a certain postmodern or perhaps, more precisely put, post-authentic
sensibility we embrace and fear as we pop our Prozacs and Ritalins
and decide to be Jewish and then Episcopalian and then chant with
the monks on some high Himalayan mountain via a cheap plane
ticket we purchased in between jobs and just before we sold our
condo in a market rising so fast that when it falls it will sound like
all of the precious china plates crashing down from the cabinet--a
mess. What a mess!

Over and over again, from the Middle Ages on, when the
theologian Pico wrote, in a direct and influential challenge to the
Platonic idea of essential forms--"We have given you, Adam, no
visage proper to yourself, nor endowment properly your own ...
trace for yourself the lineaments of your own nature ... in order that
you, as the free and proud shaper of your own being, fashion
yourself in the form you may prefer.... [W]ho then will not look
with awe upon this our chameleon ..."--over and over, since those
words at least, we as human beings have fretted about the question
of whether there is anything fixed at our core, any set of unalterable
traits that make us who we were and are and always will be.
Postmodernism, by which I mean the idea of multiplicity, the
celebration of the pastiche, and the rejection of logical positivism
and absolutism as viable stances, will never die out, despite its
waning popularity in academia. Its roots are too deep and ancient.
And there has been, perhaps, no field like modern medicine, with
all its possibilities and technological wizardry, to bring questions of
authenticity to the burning forefront of our culture. At what point,

in altering ourselves, would we lose our essential humanity? Are
there any traits that make us essentially human? When might we
become monsters or marvels, or are we already there? I vividly
remember reading a book by a woman named Martha Beck. She
had given birth to a Down syndrome child and she wrote in a few
chilling sentences that because of one tiny chromosome, her child,
Adam, is "as dissimilar from me as a mule is from a donkey. He is,
in ways both obvious and subtle, a different beast." Is it really that
simple, that small? One tiny chromosome severs us from the human
species? One little wing and we're gone?

As for me, I am an obsessive. I like my categories. I check to make
sure the stove is off three times before I go to bed. I have all sorts
of other little rituals. At the same time, I know I am deeply
disrooted. I left my family at the age of fourteen, never to return. I
do not know my family tree. Like so many of us, I have no real
religion, which is of course partly a good thing but partly a bad
thing. In any case, last year, in some sort of desperate mood, I
decided to convert from Judaism to Episcopalianism, but when it
came time to put that blood and body in my mouth I couldn't go
through with it. Was this because at bottom I just AM a Jew and
this amness has profundity? Or was this because I don't like French
bread, which is what they were using at the conversion ceremony?
In any case, at the crucial moment of incorporation, I fled the
church like the proverbial bride who cannot make the commitment.

I want to believe there is something essential and authentic about
me, even if it's just my ears. And although my feelings of diffusion
may be extreme, I am certainly not the only one who's felt she's
flying too fast. Lifton writes, "Until relatively recently, no more
than a single major ideological shift was likely to occur in a
lifetime, and that one would be long remembered for its conflict
and soul searching. But today it is not unusual for several such
shifts to take place within a year or even a month, whether in the
realm of politics, religion, aesthetic values, personal relationships.
... Quite rare is the man or woman who has gone through life
holding firmly to a single ideological vision. More usual is a
tendency toward ideological fragments, bits and pieces of belief
systems that allow for shifts, revisions, and recombinations."

What Lifton has observed in the psyche Rosen wants to make
manifest in the body. I ask Rosen, "So, do you believe we are just
in essence protean, that there is nothing fundamental, or core, to
being human?"

He says, "Lauren, I am a scientist. My original interests were in
nerves. I helped develop, in the 1980s, one of the first
computer-grown nerve chips. The answer to your question may lie
in how our nervous systems operate."

PART III: THE PROTEAN BRAIN

First, a lesson. In the 1930s, researchers, working on the brains of
apes, found that the gray matter contained neural representations of
all the afferent body parts. Ape ears, feet, skin, hands, were all
richly represented in the ape brain in a series of neural etchings,
like a map. Researchers also realized that when a person loses a
limb--say, the right arm--this portion of the neural map fades away.
Sometimes even stranger things happen. Sometimes amputees
claimed they could feel their missing arm when, for instance,
someone touched their cheek. This was because the arm map had
not faded so much as morphed, joined up its circuitry with the
cheek map, so it was all confused.

It was then discovered, not surprisingly, that human beings also
have limb maps in their brains. Neurologists conceptualized this
limb map as "a homunculus," or little man. Despite my feminist
leanings, I am enchanted by the idea of a little man hunched in my
head, troll-like, banging a drum, grinning from ear to ear. Of
course the homunculus is not actually shaped like a human; it is,
rather, a kind of human blueprint, like the drawing of the house in
all its minute specificity. Touch the side of your skull. Press in.
Buried, somewhere near there, is a beautiful etching of your
complex human hand, rich in neural webwork and delicate, axonal
tendrils designed to accommodate all the sensory possibilities of
this prehensile object. Move your hand upward, press the now
sealed soft spot, and you will be touching your toe map. Your eye
map is somewhere in your forehead and your navel map is
somewhere in your cerebellum, a creased, enfolded series of cells
that recall, I imagine, ancient blue connections, a primitive love.

Today, Rosen is giving a lecture. I have come up to New
Hampshire to hear him, and, unlike on the last visit, the day is
beautiful and bright. Rosen explains how brains are truly plastic,
which comes from the Greek root meaning to mold, to shape.
When we lose a limb, the brain absorbs its map or rewires it to
some other center. Similarly, Rosen explains, when we gain a limb,
the brain almost immediately senses it and goes about hooking it up
via neural representation. "If I were to attach a sonographically
powered arm to your body," Rosen explains, "your brain would
map it. If I were to attach a third thumb, your brain would map it,
absolutely. Our bodies change our brains, and our brains are
infinitely moldable. If I were to give you wings, you would
develop, literally, a winged brain. If I were to give you an
echolocation device, you would develop in part a bat-brain."

Although the idea of a brain able to incorporate changes so
completely may sound strange, many neurological experiments
have borne out the fact that our gray matter does reorganize
according to the form and function of our appendages. Because no
one has yet appended animal forms to the human body, however, no
studies have been done that explore what the brain's response to
what might be termed an "evolutionary insult" would be.
Assuming, probably wrongly but assuming nevertheless, that
human beings represent some higher form of species adaptation, at
least in terms of frontal-lobe intelligence, the brain might find it
odd to be rewiring itself to presumably more primitive structures,
structures we shed a long time ago when we waded out of the
swamps and shed our scales and feathers. Rosen's desire to meld
human and animal forms, and the incarnation of this desire in
people like the cat-woman and the lizard-man, raise some
interesting questions about the intersection of technology and
primitivism. Although we usually assume technology is somehow
deepening the rift between nature and culture, it also can do the
opposite. In other words, technology can be, and often is, extremely
primitive, not only because it allows people a sort of id-like,
limbic-driven power (i.e., nuclear weaponry) but also because it
can provide the means to toggle us down the evolutionary ladder, to
alter our brains, stuck in their rigid humanness, so that we become
what we once were phylogenetically: tailed, winged, at last no
longer landlocked.

All this is fascinating and, of course, unsettling to me. Our brains
are essentially indiscriminate, able to morph--like the sea god
Proteus himself--into fire, a flood, a dragon, a swan. I touch my
brain and feel it flap. Now I understand more deeply what Rosen
meant when he said, "Plastic surgery changes the soul." To the
extent that we believe our souls are a part of our brains, Rosen is
right. And, all social conflict about its place in the medical
hierarchy aside, plastic surgery is really neurosurgery, because it
clearly happens, at its most essential level, north of the neck. When
a surgeon modifies your body, he modifies your oh-so-willing,
bendable brain.

I get a little depressed, hearing this lecture. It seems to me proof at
the neuronal level that we have the capacity to be, in fact,
everything, and thus in some sense nothing. It confirms my fear
that I, along with the rest of the human species, could slip-slide
through life without any specificity, or "specieficity." Last year, I
had my first child. I wonder what I will teach her, what beliefs
about the body and the brain and the soul I really hold. I think, "I
will show her pictures of her ancestors," but the truth is, I don't
have any pictures. I think, "I will teach her my morals," but I don't
know exactly what my morals are, or where they came from. I
know I am not alone. Like Rosen, perhaps, I am just extreme. Now
I feel a kind of kinship with him. We are both self-invented,
winging our way through.

Rosen comes up to me. He is finished with his talk. "So do you
understand what I mean," he asks, "about the limitlessness of the
brain?"

"Does it ever make you sad?" I say. "Does it ever just plain and
simple make you scared?"

Rosen and I look at each other for a long time. He does seem sad. I
recall him telling me once that when he envisions the future fifty
years out, he hopes he is gone, because, he said, "While I like it
here, I don't like it that much." I have the sense, now, that he
struggles with things he won't tell me. His eyes appear tired, his
face drained. I wonder if he wakes in the middle of the night,
frightened by his own perceptions. Strange or not, there is

something constant in Rosen, and that's his intelligence, his
uncanny ability to defend seemingly untenable positions with power
and occasional grace. In just three weeks he will travel to a remote
part of Asia to participate in a group called Interplast, made up of
doctors and nurses who donate their time to help children with cleft
lips and palates. I think it's important to mention this--not only Bin
Laden, bandwidth, anthrax, and wings but his competing desire to
minister. The way, at the dinner table, he tousles his children's hair.
His avid dislike of George W. Bush. His love of plants and
greenery. Call him multifaceted or simply slippery, I don't know.
All I do know is that right now, when I look at his face, I think I
can see the boy he once was, the Seventh Fleet ship, the wonder,
all that wonder.

"Do you and Stina want to go out for dinner? We could go
somewhere really fancy, to thank you," I say, "for all your time."

"Sure," says Rosen. "Give me a minute. I'll meet you in the
hospital lobby," and then he zips off to who knows where, and I am
alone with my singular stretched self on the third floor of the
Dartmouth-Hitchcock Medical Center. I wander down the long
hallways. Behind the curtained cubicles there is unspeakable
suffering. Surely that cannot be changed, not ever. Behind one of
these cubicles sits Sweeny, and even if we learn to see him as
beautiful, the bottom-line truth is that he still suffers. Now I want
to touch Sweeny's dying face. I want to put my hand right on the
center of pain. I want to touch Rosen's difficult face, and my baby
daughter's face as well, but she is far from me, in some home we
will, migrants that our family is, move on from sometime soon. I
once read that a fetus does not scar. Fetal skin repairs itself
seamlessly, evidence of damage sinking back into blackness. Plastic
surgery, for all its incredible advances, has not yet been able to
figure out how to replicate this mysterious fetal ability in the
full-born human. Plastic surgery can give us wings and maybe even
let us sing like loons, but it cannot stop scarring. This is oddly
comforting to me. I pause to sit on a padded bench. A very ill
woman pushing an IV pole walks by. I lift up my pant leg and
study the scar I got a long time ago, when I fell off a childhood
bike. The scar is pink and raised and shaped like an o, like a hole
maybe, but also like a letter, like a language, like a little piece of

land that, for now, we cannot cross over.

(*) Not his real name.

Lauren Slater is the author of Prozac Diary, Welcome to My
Country, and Lying.

COPYRIGHT 2001 Harper's Magazine Foundation in association
with The Gale Group and LookSmart.
COPYRIGHT 2001 Gale Group